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tv   Veterans Affairs Sec. Wilkie on Presidents 2020 Budget Request  CSPAN  March 29, 2019 4:36pm-6:36pm EDT

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coverage online at c-span dorgan free c-span radio app. veterans affairs secretary robert wilkie and other v.a. officials testified about president trump's 2020 budget request. members of the senate veterans affairs committee ask about health care access. senator johnny isakson chairs the committee.
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senator isakson: welcome to the hearing and get good results and moving in the right direction. the committee and the v.a. had a good year last year. we had a lot of things squared away. we got some laws passed you wanted for some time. and we gave them to you and look
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for the results and making sure we are making progress with the results, not just promises and i think we will be able to do that. this is an important meeting today. annual review of the budget. the president's budget came out a few days ago. the v.a.'s budget is a significant one. and significantly increased. we have a unique situation. we get more money than anybody in increases every year. as a percentage, however you want to calculate it. money is not our problem. yes, it is. i needed this much more, i can do this. we looked out for our veterans and knowing paying for veterans they earned and have to finance. and i'm proud the president's udget is up 9.5 and $220 billion. and that's a huge budget. what i want to do is focus on
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this year and how we did where we are. i thank the v.s.o.'s. i changed the way. they came in with a second panel. first panel was the secretary. second panel was all the v.s.o.'s. that took a lot of time and diminished each person's testimony and we just meeting with all the v.s.o.'s the last five weeks. so the important thing i ask the v.s.o. is submit their testimony in writing and submit the questions they want to have answered in writing and we get those. and they submitted some terrific questions and prompted great thought on my part and other members' part. just because i didn't include
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you in terms of verbal testimony at this meeting, i want to say what we heard got done. we'll follow up on it rather than have it lost in the system once you set it here. second thing i want to talk about two meetings we have coming up and i try to keep my promises. we have done amazingly well on that. and we had cooperation by all. senator manchin had asked for a discussion on burn pits and toxic exposure. we will have a meeting on toxic exposure and come later in the year after we have begun to swallow the blue water navy. my understanding is that that the blue water navy court decision is not being challenged, is that right? secretary wilkie: that would be my recommendation.
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senator isakson: v.a. has recommended that and i appreciate that and i offer that opinion. and if that happens, we will be in the process of beginning to swallow a big bite and chew it and dissolve it. i was happy to learn from the secretary, that 51 people have already been treated. that -- is that correct? secretary wilkie: 51,000. senator isakson: i appreciate the secretary and v.a. doing a thorough job as far as blue water is concerned. hopefully that will continue. the other is access data. big fellow sitting to my right has made it clear to me that access is a big thing for him. if you think about it, the recently published for comment rules and standards for access of community care. once those are finished, in
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alaska and kansas and north dakota and south dakota, georgia, montana, everywhere, more rural veterans, it's important to get them the care they need as quickly as we can. get a system that works. doctors want to be part of it. third-party administrators working to get doctors to meet the standards. it's just terrific. i'm going to focus on access standards in the next meeting on april 10. and we will focus on access standards. i encourage everybody to be there. if we do one thing this year and get that working, that is the part that is hard, the most problems and we can get it working right for the v.a. and veterans and right for us and take care of our single biggest problems. so with that said, i'll end my
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opening remark and turn -- have i welcomed the secretary. i'll let you have your opening. senator tester: i welcome secretary wilkie and dr. lawrence and dr. stone and mr. rychal sky to the hearing today. i want to thank your team and thank you for what you guys do every day. the chairman talked about access standards and will be talked about a lot today. we talked about privatization. i don't believe any of you want to see that happen. but it's something i'm concerned about because the big boss talks about it all the time. in the end, as the v.s.o.'s told us a couple of weeks during a joint veterans affair committee. that's a good thing. i think that's a very good
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thing. you guys are doing some things right. we'll talk about a few things that you might not be doing so right and i apologize. but these are folks that served our country and we need to make sure to live up to the promises we made to them. over the past few years, this committee has heard from the v.a. about what it needs to be success tl. we have engaged with the v.s.o.'s to see what they wanted in their v.a. and i will tell you this committee listened and we acted, leading the way on monumental reforms that a lot of people didn't think we could do. this is important part of our job, providing you the tools that you need to do your job. equally critical, though, is your job is deciding how you the new authorities are utilized and that is whereas i have said already my concern is.
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the level coming from congress to address health care vake cans cyst and needs at the v.a. needs to be matched by the department. i have talked about my interests in montana and will talk about it today. fort harrison. it was one of the top v.a. facilities. it has one primary care physician. part-time doctor who sees a handful of patriots. i have c-box with no advanced primary care doctors and where that care is only provided through telehealth. it does great things with folks who have mental health issues but cannot replace all types of health care. you get the frustration. this is about investments in community care and i don't want it to be at the expense of
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capacity building initiatives. i don't want our investments in community care to be at the expense of capacity building initiatives. as we have discussed, there is a role in the private sector especially in a rural state like montana and other states, too. we have to be careful we don't take the department down a dangerous path. you can outsource the care but can't outsource the responsibility. when they are sent into community care without first knowing if that care can be provided in a timely manner and if it's quality care, we are going to pay the price for that later. the veterans are going to come back and say why. i think we need to hold our v.a. providers to one set of standard and community care providers to that same set of standards. none of us want a flood of veterans going to community care if it has lower quality and less
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timely. and we can't head down a path without a firm gasp of how much it's going to cost the american taxpayer. we received multiple estimates from the department how much it would would cost to lead up to the budget request. none of those estimates matched the number that appeared in the budget request. as we go forth, i would like to clarify why that is. so it's not clear how that estimate came about and not clear whether the technology you need to implement this program will be ready in time for implementation. i have been receiving conflicting reports about the readiness of this tool and i'm frustrated that we are hearing about i.t. solutions. there is a huge amount of i.t. money. as you know, the v.a. has i.t. led in the years for
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i recently had a great meeting with jim, but there is no o.i.t. representation here from the department today. and so i hope that's not a reflection of how this issue is being prioritized. i know the table is short and you have to pick and choose. we have see how it affects veterans and how v.a. is replacing an old system. by the way, we are here today with the mission program as a direct result of i.t. failures in arizona. so this is a big thing. we need to work. you have a great team around you, mr. secretary. i think you are a great guy and right guy for this job and i'm glad you're there, but we need to find out the details of this budget. as we move forward, i do not want to see v.a. care dollars transferred to community care because we ran out of money in the community care budget.
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with that, thank you all for being here and thank you, mr. chairman for the opportunity to speak and i look forward to this hearing. senator isakson: thank you, senator tester. our hearings with the v.s.o.'s we ain't going to privatize. i didn't have anyone throw me down the steps who wanted to the privatize the v.a. and put that sign behind the bathroom door and making the best v.a. they like their v.a. and they call it my v.a. and we will make it better in accountability and results. with that said, talk about better, we have the best guy you could ever have. robert wilkie, i did not know him until he was appointed. first time we met. and i he has a good bedside
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manner. easy to talk to. he is very easy going and knows some great jokes that are all clean. terrific guy. but he doesn't just have a good personality and good demeanor but he likes to get the job done and he holds himself accountable and i appreciate that. with his type of per sona we are seeing improvements and results in the v.a. we have a long way to go. they do a lot of things well. get t to do better and those problems solved. committed to is doing it and finish the job but continue the job of improving health istration of care to our vets. you are a good southern boy.
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great secretary of the veterans' vacation and i appreciate what he does and proud to introduce him as much time he might onsume secretary wilkie: thank you for the courtesy and thank you for the kindness that you have shown me. i'm going to take a point of personal privilege and thank you for the support you have given me. i came to this having been the under secretary of defense for personnel and readiness. i was raised in the military world. my service compared to my ancestors is incredibly modest. but it is service nonetheless and i have been privileged to see the military life from many angles. so there is no higher honor than to be sitting here before you. i am pleased to have with me and
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i'll start on the left side. hn rychalski is our budget guru and chief financial officer. dr. richard stone is executive in charge of v.h.a. and our misrecent award winner who just received an award for being the government's best senior executive and that is dr. paul lawrence. and i thank them for coming. when i last reported to this committee, mr. chairman, in december, i said that the state of v.a. is better. i believe from the statements that you have made and from the statements senator tester have made as well. i count that to the support of this committee. earlier this morning i addressed at the house doctors' caucus and i said the changes made in v.a. were not driven by the executive
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branch but came from the two authorizing committees. i argue it is the most transformative period in the history of this department going back to omar bradley's day and we are not any longer on the cusp of transformation but in the middle of it. before i talk about that, i talk about the trajectory that v.a. is on. in the last month, we had some excellent news. in most of my career in and out of government, v.a. has always been rated 16-17 or 17-17 in terms of the best places in government to work. the partnership for public service for the first time said we are no longer there. we are in the top third and moving in a higher direction. so if we have customer service amongst ourselves, we will provide good customer service to
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those that we are honored to serve. senator tester implied that the medical care that v.a. gives is good or better than any medical care in any region of the country. we are proud of that. and last, the journal of the american medical association said that our wait times in the foremost important categories of medical care are as good or bet are are arer than in the private sector. that is an indication of where we are headed in our department. the major driver of transformation is the act. it simplifies and consolidates v.a.'s programs into a simple to use program and expands the caregiver program and provides a new urgent care benefit as well as other access improvements. regulation setting new access standards ensuring better choice
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for veterans will be completed in june. we have proposed a 30-minute average drive time standard for primary care and mental health care and 60-moint drive time for specialty care. we have proposed appointment wait times for 20 days of primary and mental health care and 28 days from the date of request with certain exceptions and i want to address the privatization argument. i come from the conservative republican side of the aisle. the issue that has been raised many times about privatization is just not borne out by our budget by the directions of this committee and i'm here to say that the care in the private sector nine times out of 10 is probably not as good care in v.a. one of your colleagues gave an interview in one of the state's
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newspapers and disappointed in the wait times for certain services at v.a. in one of his major metro areas. the wait time was 12 days for v.a. in the major metro area it was 78 days. so that also is an indication that we are moving in the direction that you appointed for us and the direction that veterans deserve. things are not always greener on the other side of the hill. at the same time, we are trying to move out in making v.a. a modern 21st century health care administration. no longer will we have an ad hoc supply chain. we are tying in with the department of defense and their computerized systems for medical supplies. the days with v.a. doctors at the d.c. v.a. have to run across the parking lot to find
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equipment have to be over if we continue the road of improvement. the other part of our major transformation is the electric tron health records where we tie in with the d.o.d. the minute that young american walks into the processing station so we have a complete picture of that veteran's health. the chairman mentioned burn pits. for the first time when this is online, v.a. doctors will be able to see everything that had happened in that soldier's life from exposures to toxics overseas from exposures to toxics in the continental united states and will we will know how to serve that veteran. i have been asked to lead the national suicide prevention task force. that is one of three areas that v.a. is moving out on in response to this committee for senator manchin, it's the opioid
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epidemic and begin to change the way we treat our veterans. homelessness is another area and then suicide prevention. in the last year, we have hired over 3,900 mental health professionals and provide same-day mental health service for veterans. as part of the continued transformation, we are also engaging in the creation of a modern h.r. system. right now there are 140 h.r. offices across v.a. and consolidating those down to 18. and for the first time bringing in h.r. officials to create a modern human resource capability that will send doctors, nurses and health care professionals to those parts of the country where they are most needed. as for the budget, the chairman is right.
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$220 billion budget. $9.5% increase over what v.a. had last year. that's $97 billion in iscretionary spending. $123.23 billion in mandatory spending and funding for 493 full-time employees which is an increase in 13,000 for those working at v.a. that means for the mission act, 19% of the funding will go to community care but 81% for v.a. care. 1.6 billion to the electronic health record. $184 million for modern integrated financial acquisition management system and $36 million for us to continue to adopt the defense medical logistics medical support system. $8.1 million to improve customer service, the prime directive of those in v.a.
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$547 million for women's health and $1.6 billion for capital investment. the last item on my list is to ntinue my predge to you that we be an open department. we are joined at the hip with this committee and with the committees of the house of representatives. we all have the same mission in mind and again, i thank you for your courtesy. and i think for allowing the honor of serving in this capacity and i look forward to our questions.
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senator isakson: when you refer to the improvements that you referred to, how do you measure your outcomes in the v.a.? do you take them from the senior person in charge or evaluations or randomly? how do you gauge your outcomes for the services you provide to our veterans? secretary wilkie: i look to the veterans in the eight months i have been in this chair reaching out to veterans in terms of surveys and interviews. what i have seen is that our customer satisfaction rates are moving in an upward direction where we have an 89% customer satisfaction rate amongst veterans. in terms of other metrics,
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opiods is the outstanding example, how are we changing the way that we approach this national tragedy. and we approach it in changing the way that we treat our veterans by providing things that somebody like my father, 30, 40 years ago with , ternative medicines, tai-chi yoga. we are on the cutting edge of alternative treatments to our veterans. we are on the cutting edge of telehealth, as senator tester said and cutting edge in terms of tackling the national epidemic of suicide and homelessness. it's a combination of things but for me, most important is listening to what our veterans say. senator isakson: let me say this , is the budget and
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recommendations you have have includes retiring two i.t. systems you have in the v.a. the v.a. is a place where you collect software and systems and people bought things over the years, they don't talk to each and not getting good bang for your buck. i would like to talk about retiring those programs and overall picture. secretary wilkie: eight months ago that the overall condition of v.a.'s i.t. system was bad. as a result of that, this committee is looking a massive increase in our budget, $4.2 billion, i believe. but that money in the past has been spent on redundant systems. going down the same road that
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led to the failure in the forever g.i. bill as well as other systems. so what we are doing and you will have the c.i.o. up for testimony in the next few weeks, is we are beginning to mige great legacy systems out and bring the v.a. in line through the cloud. we have 8,000 employees who are dedicated simply to that transition. we will ask for a bit of patience on some of these. but the migration to the cloud is the wave of the future and it is the way that we will maintain the trajectory that v.a. has undergone in terms of its overall customer service. but are absolutely right. the reason the forever g.i. bill crashed and burned and the
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directions from this committee were placed on a 40--year-old system. it was bound to fail which is one of the reasons why i pivoted to make sure our veterans got their checks. senator isakson: i'm not going to ask another question but make a statement. i'll make an admission, too. the state of georgia brought me in when they lost their schools in the middle of an election cycle to take over the board of education and the department of y2k. ion going to and sails people come in and talk to you. and you don't understand. i want to find that damn cloud. if i said this was the solution. i just can't find it anywhere. my point is this.
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so many times when we go to clean up a system, technology information, we have to buy more stuff to clean up the mess and we have a bigger mess and we haven't solved the problem which is the sbrp operability. so let me encourage you to make sure we have the right people and making the decisions or recommendations to you and understand technology and what it can and cannot do and don't buy everything that comes in through the front door because that gets expensive. the v.a. is so big, the budget is so big, you are talking any problem in the v.a. is a big cost, particularly if it's the i.t. system. i appreciate what you are doing. mr. tester. enator tester: thank you for
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being here. i haven't met a veteran in my state who want the v.a. to be privatized. but here's the troubling thing we had. our request is 44% decrease. mpmamp in a rural state, our mobile unit in clarks burg is totally inoperable. our medical centers haven't had increase in residential rehab centers since the 1950's and 1960's. deferred maintainance for roofs, hvac, all of the above. i'm worried that even though our intent and the verbal agreement that we have that we don't want to privatize because of starving
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some of the things, people would say i would rather not go to that because it doesn't have proper services or updated equipment and leads me into nother question is that over 40,000 vake cans cyst at any time any moment in the v.a. this morning, 138 positions posted in my state. 138. i've got card oolingists, practitioners in martinsburg. we are hurting all over the board. even though the intent might not be there, but the signs show we are moving in that direction. if our veterans aren't get inthe care, they are going to say i need better care and the facility isn't worth going to because it's not in good enough shape. you can see the concerns what we have and what we have to answer
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to to. ecretary wilkie: let me take your comments. first, i would be lying to you if i told you that we are anywhere near turning the corner on capital investment. more than half of the buildings i'm responsible for age in range from over 50 years to 100 years. but this committee has provided the way forward. we are now engaged and i believe it was senator moran's idea with market assessments of our national infrastructure and our human resource needs that will then inform when they are done
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what this committee told us to create and that is the asset infrastructure review commission to bring our facilities up to speed where the veterans are. again, this is a monumental problem. my first job is to do as much as i can to ensure that the basic health needs of the veterans are taken care of. and unfortunately their cost benefit analyses have to be made and i can't come to you and say give me $60 billion to repair all of those facilities. human resource side, you are absolutely right. let me tell you where we are headed. my first week in office, i had two senior leaders give me two different numbers as to how many employees we had. now that's outrageous and i asked the military question, where is your manning document.
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a manning document is where you have the requirements and the people to maff them. we never had one. we have a modern h.r. team in place that has come in the last few months at my direction and consolidated and in the process of consolidating 140 individual h.r. offices into 18. so that we have an even distribution of resources across the enterprise. we have asked for the resources to hire 13,000 people. senator tester knows, my emphasis as the hid of v.a. has been for rural america. rural america and native america. those two sections of the section that provide the highest per capita number of men and women in uniform and for the native populations, the population, it provides the highest in the medals of honor
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and combat decorations. it is a complex problem if i said we are near turning the corner. mampmamp my time is up. i speak to veterans all over my state and i tell them and do not believe we intend to build brand new v.a. facilities. they say can't you at least take care of what we have. and i hope you understand it. they are scared to death they are being set that this is going to go private. the manual switch at facilities are not adequate. > may i ask your indulgence. senator till is is here and has one of the fastest growing populations in the country. in fayetteville, my hometown,
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two massive v.a. facilities, the new one is leased. the v.a. center director doesn't have to worry about hvac or the lawn, concentrates on taking care of veterans. we have to be more creative in terms of two things, one how we manage our infrastructure which mission act tells us to do better and two giving more incentives and i want to come to this committee and talk to it, something like a veterans peace corps to get medical professionals out in rural west virginia and rural north carolina and provide the means to serve veterans in those communities that are hard to reach yet provide the highest percentage of service to anyone in the country. senator isakson: senator cramer. senator cramer: thank you, mr. secretary, for being here. thank you for our previous
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discussion. i will ask my questions specifically to you and you can defer them to others if it is more appropriate. you talked a fair bit in your testimony about alternatives to pain management, alternatives to opiods and you talked about something like ack cue puncture and other times of care. but you didn't talk about the chamber treatment and particularly for pain. we found it to be effecttive and other types of treatment like post-traumatic stress, brain injuries, things common to veterans and athletes. i wonder why and what do you think the potential is for that? secretary wilkie: it wasn't for lack of appreciation of the treatment and i pledge to you that i will be out in fargo to look at the headquarters of one of america's largest chambers.
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we have to be more creative. particularly as treatments become more complex for more complex injuries, particularly the injuries of the brain. we are not at the sputnik stage when it comes to exploring the brain and how it responds to trauma and how it recovers. and dr. stone is probably the better expert when it comes to the actual medical conditions that that treatment addresses. practitioner who ent my career in this, but using this to heal the brain or to do some of the work that you have been discussing is work that's been studied for at least a decade in both d.o.d. and v.a. at we know is that the
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chambers have a dramatic effect in improvement of individuals with ptsd as well as bain injuries. what we don't understand is what the addition of oxygen to the presence in that chamber does. and so there has been multiple studies done by the v.a. demonstrating that and look forward to further research on it. brain ress remains one of the mainstays and going into a chamber where there is silence is great value. whether the addition of oxygen under pressure remains in debate. senator cramer: my understanding is that the presence of more oxygen could have the alternative impact because it is sometime youlative, i would guess. mr. stone: in the presence of
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trying to penetrate oxygen into wounds, that's exactly correct. senator cramer: we would love to help you for that experimentation. the other thing i wanted to mention because you mentioned it in your testimony, 13,000 more people and you are in the people business. it requires practitioners to do the work and they do it really well in fargo and pleased of the service they provide our veterans. but it's getting harder to find good people and attract them and keep them. particularly in an economy like north dakota has, it's even elevated there. the challenge is amplified in an economy and in the region. and rural states. that said, can you elaborate on specific programs whether it is loan repayments. what are some of the tools that
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we could help you with to attract and mape and keep good people? secretary wilkie: the chairman and ranking member inserted into the mission act the first monumental step in addressing the great needs of rural veterans by giving us the extra authorities on relocation pay, reimbursement. the ability to pay off medical school loans. those are absolutely needed. my goal, though, is to try to create an even morrow bus relationship with our universities and also with the armed services. general bradley's goal was to have at least half of the doctors and nurses coming off of active duty come into v.a. we spoke a great deal about that.
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we are now telling doctors when they decide to leave active service come to v.a. to continue your service to those who have worn the uniform. i want to go back to the future on that. this committee has given us a start particularly when it comes o rural america. [indiscernible] senator isakson: i just heard that. i don't know if that's true or not. mr. moran. mr. blumenthal. senator blumenthal: i hesitate but terrupt senator moran, will. thank you, secretary wilkie and your team for being here today and thank you on your announced
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decision that you would not be appealing the ruling of the urt in the blue water navy case. [indiscernible] senator blumenthal: i think your recommendations will be key. it is instrumental. i would perhaps with all due respect, mr. chairman, express on my behalf and i hope on behalf of the committee on veterans affairs that that recommendation be adopted and endorsed hartley to bring fairness and justice to our blue water navy veterans. it would culminate a crusade that has been bipartisan involving almost everyone on this committee. it has been a team effort and i'm grateful to you for making that recommendation. i also want to submit for your consideration the agent orange exposure fairness act, which would extend the basic
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principles of that court decision and suggest also that there are other toxic chemicals and poisons on today's battlefields that are worth the research and attention that the v.a. should give them in deciding what kinds of benefits and disability compensation our veterans deserve. the potential for poisons on the battlefields is one of the great challenges of our time, one of the areas of unknown consequences to our heroes in uniform and as a father of two veterans who have fought in recent wars and a friend of many , i hope that we can carry forward the spirit of that court decision and of your support for it. i want to move to the veterans
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affairs health care system, most especially, in particular the v.a. facility in west haven. si think you are familiar with my letters to you on this topic. understand sterlsation processes there have been stalled so the operating facilities are at one-third at capacity. 2/3 of the veterans who need surgery at the west haven facility are either sent elsewhere or surgeries are delayed or possibly denied and that is because the starlization capacity is limited. the facility was closed because f flooding but the tools and
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equipment cannot be properly sterilized. a mobile trailer is planned a year from now. a permit in the event facility, five years from now. much too long. i would like to know for expediting the availability of that surgical process. secretary wilkie: i know how important west haven is. dr. stone is supervising that. i do want to step back and say, i agree with you in some of your earlier statements about the burn pits. we don't want to go through what we went through in agent orange. i saw that in my family and i worked with senator till is on the burn pit legislation that he and senator klobuchar passed a few years ago and i will let dr.
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stone talk about west haven. mr. stone: we appreciate your role in the recovery of west haven. this goes back to the fact that this is an older facility and steam line running under the sterilization area. let me reassure the surgery being performed in that facility is safe. senator blumenthal: i don't doubt that it's safe. he staff are doing their best. in no way are they compromising the safety or effectiveness of the surgeries they do. they are to be commended. the v.a. is failing them by ailing to expedite the sterilization processes which limits their capacity. mr. stone: the mobile trailers that will bring the
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sterilization materials will be installed by june of this year and the major holdup was because of utility issues and the building of the trailer. the actual funding of a new sterilization facility will take three to five years. that said, my expectation is that as soon as that mobile unit is installed this june, we will begin to recover the surgery that needs to be done at that facility. senator blumenthal: will it go to 100%? mr. stone: that's my intention. plutonium blume can you make that commitment? mr. stone: absolutely. secretary wilkie: i'll make it. senator blumenthal: my time has expired. and i thank the chairman about the possibility of expediting a more permanent facility. but i appreciate your commitment today. >> thank you for conducting this hearing.
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mr. secretary, thank you for being here. i join the ranking member and chairman for your continued service to those in uniform and i appreciate the job you are doing at the department of veterans affairs. i'll have a chance in senator boozman's chairman about the spending and budget recommendations. i have a couple of things that i think are timely that i want to ask you today while i have this chance. first of all, i would like to highlight for you in 2014, we authored legislation and working with senator brown of ohio. but the national academy of medicine was required to do an analysis to determine if there is any medical and scientific evidence or whether there needs to be studied of the problems, challenges following generations of the service man or woman now faces as a result of toxic
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exposure and look forward to find the answer. there may be a whole another generation. it saddens me thinking they may harm their children or grandchildren but that may be the case and working to get the medical and scientific evidence. i want to highlight a piece of legislation that senator tester led and i joined him in introducing related to mental health and suicide prevention. and i look forward to getting input from all my colleagues with senator tester's leadership -- >> that's the reserve and guard. senator moran: the commander being a hammond veteran who lived in the state of montana. my two questions on the timeliness of this hearing. staff of this committee, the
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house committee and the staff of our individual senators on the committees met with your staff in regard to the veterans hearing aid access and assistance act. for as poorly as senator tester and i get along, it was passed into law in december of 2016. and the takeaway from that meeting -- first of all, i should indicate that legislation in 2016, the law mandates that the department of veterans affairs determined criteria for haring aid specialists. then with the goal of integrating them into the care of veterans that the v.a. serves. but the unfortunate circumstance since 2016, we can find no evidence of the v.a. taking any steps to implement that mandate and the meetings that i think i would describe the takeaway little interest in meeting that
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mandate. we ask for a response from v.a. officials by today's hearing knowing that you would be here and we received none to date. perhaps dr. stone appears to be interested in talking about this conversation. mr. stone: senator, thank you. i was unaware of the letter. if we have not responded, you have my apologies. senator moran: we didn't send a letter but conversation with the officials at the v.a. saying the secretary will be here on tuesday, can you get back to us by then otherwise we need to raise this topic with the secretary. mr. stone: you are looking at a compromised veteran from my combat service. and as we have sought care for hearing loss due to combat. i'm well aware of the issues that you bring up. and let me say to you that we last year performed over one
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million visits for hearing-compromised veterans with our audio and we appreciate the legislation on hearing aid specialists. the question is, do we need to move into the specialist area? clearly, you and i may have a different understanding of the role of specialist. today i have enough audiologists and enough him and him and audiologists and enough technicians in order to provide that vast majority of care that is needed. including less than a 10 day in waiting period in order for
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veterans to come in for care or for appliances. in addition we have and under two week waiting period in order to take outside prescriptions and sell them on behalf of the veterans. >> let me suggest this that senator tester and i staff could have this conversation. i am an employee of kansas on saturday, for days from now. there two days of service and fairly a physician has a mid- level petitioner. the department, the eastern division in kansas has announced the closure of it. one would expect me to be angry about the closure. i am hopeful that with the closure and conversations with the va that the mission act now provides additional opportunities for care for veterans because we go from a physicianh often no and one mid-level to an opportunity for a multitude of community resources being available to those veterans in the area. i'm going to meet with your folks in kansas. what message would you like for the missionr about
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can provide? the mission act is about veterans and centered care. it is not about protecting the institution or guarding the status quo. it is about giving the veteran the option to be the garden of his own or her own future. and for rural america, offering a wide as aperture possible of access to medical care, meeting the attention of this committee and as long as we keep veterans health at the center of everything we do, the system will work. >> i will convey that to the veterans that join me saturday. mr. chairman, thank you. >> in keeping with our bipartisan committee commitment i'm going to excuse myself a minute and send it over to senator tester to continue the hearing and it is his turn to answer questions. >> thank you mr. chairman.
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i assume that means i can expand the time i used. thank you all for being here. once again, i hesitate to talk history with somebody who probably knows history far better than i do. -- then i do, especially military history. but nonetheless this is pretty elementary. in the 1930s, this country did not want to go to war. president roosevelt turned car factories into airplane manufacturing and prepared for war. then came the bombing of pearl harbor and we were ready for war. pretty simple, pretty ingenious. everybody on this committee, i believe has said no privatization. the president had said something different. you have said no privatization and your staff has also said that. as we questioned are asked here today, and i have talked about the vacancies and facilities
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that needed improvement. blumenthal talked about west haven, one third capacity and senator moran, even though he's not mad about it talked about closure because of a lack of a staffing. everything i'm hearing and everything i'm seeing says something different. then i looked at the budget and the budget and you said earlier billion ined $60 capital investments. the budget request for major and minor construction was decreased by 43% for major construction and 50% for minor construction. and we're talking about the needs out there. by the way, we can go down the list to montana, it is pretty reflective. i was at the meeting six days ago when you guys said you can't get the money out the door but nonetheless, you talked about $60 billion in capital expenditures and reducing those
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accounts by 40% and 50%. putting all that together, how can we justify that? >> senator tester, i could probably shed some light on that. first let me say that the department cfo, i feel dirty not asking for more money to be honest. >> i don't care if you asked for more money but if you've got $60 billion in needs over the next five years and we are reducing the same accounts to meet those capital expenditures, something doesn't jive. >> let me explain. the fact of the matter is we do have a requirement. we have older facilities and a substantial facility requirement. the fact of the matter is we have very quickly executed our shovel ready projects and they are in the works. we are at a point now when you divide the amount of money we have in the works by the number of facilities, we have 19 to 20
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projects per facility going. they have limited capacity in a lot of areas. moving clinics around, moving people around. we are now hearing from a number of facilities that they have some shovel ready products but cannot execute because it is too disruptive. we will end up carrying some of that money forward from 2019 into 2020. about $1 billion of nrm. we will also carry minor construction money. >> i will do some quick math. if you don't know this already you divide 60 by 5 and it is $12 billion a year. if that need is out there and we cannot execute the amount of money we've got so far, how do we not privatize the va? >> well, we don't privatize the va because we still have the largest healthcare system in the country.
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170 hospitals. and our veterans are voting with their feet. let me just say, this is not a libertarian v.a. if it were, i would be giving myself a card that says veteran and i go out to the private sector and get anything i want. >> i hear you. >> that is not happening. again i fall back not on anecdote, but on the stats. veterans are happy. they are going where people speak their language and their culture. i support that. this committee supports that. >> mr. secretary i agree with , you but i go back to the example of history. if we are short on manpower, if our facilities are short and substandard and we are not making the hvac additions that we need to do, eventually the veterans are going to the va and they will say, not anymore. >> this committee gave me the answer. that is the market assessments.
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then the asset infrastructure review committee which does exactly what you said. and i think i will come to you and ask to celebrate the -- to accelerate the beginning of the commission. so that it moves more rapidly than the timeline that this committee has given. >> really quick, i don't have a problem with that. can you give me an idea of how quick? 2021 orid to go in 2022. i would like to go earlier as our market assessments are underway. >> i would like to do that earlier because our market assessments are underway. i would love to visit with you. >> now we have senator rosen. >> thank you very much. we do appreciate you and senator isaacson. we can be very proud that the 2019 appropriations because of your leadership and the committee was significantly increased. i think again we will see that going into the next fiscal year.
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we appreciate your leadership secretary wilkie and your team. especially in grappling with the forever g.i. bill and getting that under control. i know that was a hard thing to do. also your work with the veteran suicide. i think we are coming up with a method now that is going to have significant results. we really do appreciate that and we appreciate that in your leadership style. and again with your team. one thing that i would like to understand, i was in arkansas last week. a lot of our smaller communities will be impacted by the mission act. and i guess what i would like to understand is there is a little bit of confusion as to what will happen in june. we have rules and regulations in
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place going forward. for the veteran in mountain home , arkansas told he is ineligible for choice because a nearby location even though it doesn't provide the medical service he needs. what will happen to him in june? if anything? will he be able to talk to the va to get authorized for care from a private hospital? what is the process? >> the process is the veteran will continue to talk to his provider or scheduler in order to get authorized care and make the best decision on behalf of the veteran. frankly, june 6 should almost be a nonevent for the veteran. today, we authorize -- we will do over 300,000 visits in our direct care system. we will authorize about 50,000 visits in the community care. that is all done on a manual basis by providers and
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schedulers. on june 6, it is our hope to have something called a decision support tool that will automate the process. should we fail with the decision support tool, it will look just exactly like it does today. now there will be an enhanced number of veterans eligible to make a decision of whether they want to go out for care or not. but the system will look very similar to what it does today. as far as a veteran sitting in as far as a veteran sitting in front of a provider or scheduler or on the phone making a decision on whether they stay or they go out for care. for those eligible on june 6 be a radically for advanced care in a sense that they will fall into that new parameters, if they call will they be told, do
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this and this or will it be, we are facing this out and call back? >> senator, this will be told what to do for care. there should be no increase in wait times. there should be no increase in wait for care. now our problem is in most areas of america, the commercial healthcare system is not as responsive as we are. please remember of those 300,000 visits we will conduct today over 22% are same-day visits. in the commercial space it is not as responsive as the secretary said previously. in an urban area, in the southeast it was found that the wait time for the commercial space was dramatically higher than ours. i would like to talk and again, mine was more in context with the travel time versus the wait time. we will talk about that.
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the veteran suicide, the collaboration with these groups that seem to be doing a good job. the secretary and i were in a meeting earlier this morning and one of the congressmen talked about a program that had a 70% reduction of suicide as a result. can you talk about the efforts and collaboration so that we can get these public private partnerships going that seem to work well. we need to make sure the metrics are there and all of those things. >> yes, the budget calls for $222 million for suicide prevention programs. i have just been named as the chair of the national task force on suicide prevention. you know the terrible statistics, 20 veterans a day take their lives. 14 of those are outside of our va. i think the most important part of the task force other than a whole health approach to suicide prevention is the opening of the window for monies to flow into
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the states and localities to help us find those veterans. for example i was in alaska with senator sullivan. more than half the veterans in alaska are not in the system. i asked the alaska federation of natives to double the number of be a tribal representatives they have to go out into the hinterland of alaska and help us find those veterans not in the system. it sounds simple and sometimes simple solutions are the better solutions. the states and localities know better than we do and many of these instances where veterans are and where they are in need. a couple of things, i'm not going to give you a metric saying we are going to achieve zero suicides. the majority of veterans who
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take their own lives are vietnam era, my father's generation. some of these americans have problems that began building when lyndon johnson was president. we are not going to be able to cure all of that. but we can and if the chair will indulge me, as the former undersecretary of defense for personnel, general mattis and i both began a system of education throughout an individual's military career that focused on mental health wellness and taught a soldier, sailor, airman, marine to look for the signs of danger. so that for the first time in our military history we actually have people coming out of the service who at least have had some educational grounding throughout their term of service in what to look for when to ask for help, not only for themselves and for others. the deepening of the relationship between the va and dod is actually essential so we
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so weabsolutely essential never again have those numbers that we have now they began to build in south east asia 50 years ago. thank you. mr. secretary, thank you for recommending the decision not be appealed at this point. appealing that decision is not what we should be using our resources for. your persuasive powers to make sure that doesn't happen. there was an article recently. way, iway, -- by the understand the chairman is going to have a hearing later on on the proposed access standards. that is good because a lot of us have expressed concern about how standards would be developed and the fact we heard from any of the as those that were not consulted during the process. that will be happening.
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a few weeks ago, mr. secretary, the new york times published a story with the heading, treat it like a piece of mead. females at the v.a.. have you read that article? it paints a pretty dire picture of the kind of experiences and harassments that the women veterans that go to the v.a. endure. what we do to make sure that women veterans are respected by staff and other patients? i realize that needs to be a cultural change but i don't know. whatever you need to do so that this is not the horrendous experience where the women veterans have described the article. i want to know whether the va is conducting research into the best practices or models of care that increase utilization and of the eight services, and your testimony mentions that 91% of va community-based clinics have a women's health primary care provider.
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and when can we expect the number to be 100%? you are almost there. >> that is certainly the goal. in our previous relationship for my former capacity as the undersecretary of defense, you and i discussed that the first thing i had to do was promulgate the first dod regulations on sexual harassment and equal opportunity, which he did. that tells you my commitment. you hit on it. it is a cultural change. i don't believe that what was in the new york times story is apparent in all of our va facilities. i'm not going to be able to tell you with a straight face that i can change the attitudes of every person who works in the va. but we are changing the culture and putting in women's health centers in all of our va hospitals. one of my goals is to make sure that there is an actual privacy barrier, separate entrances that
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in the case of this new york times story, those things would probably less likely occur. just by changing the way we bring our women veterans into the system. i can say that we had 500,000 appointments last year for women veterans. that is a change. i will also say the culture that you talked about is beginning to change within the dod. i think the longer that goes on, the less likely you will see the end product such as you described in v.a., but i think we are on the right path. when you make the cultural changes you may not need to expend resources on facilities. but obviously that is something the women veterans very clearly want at this point.
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i want to get to the lack of progress for various projects. for example the leeward , outpatient access. the project in hawaii was scheduled for the early calendar year 2018. 2018. but was delayed a number of times and the lease is not awarded. the project was supposed to be completed by fiscal year 2020. i know that these kinds of outpatient clinics, they are helpful because they are closer to where the veterans live and in hawaii, the hospital is very crowded and you can hardly get any parking. it is really a pain. commit to seeing the project will be completed on time with no further additional delays? >> senator, as you know i spent a great deal of time in hawaii last year. i talked with the governor about
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this lease. i will get you more information. my understanding was there were contractual problems with those responsible for improving the facility. that was what i discussed back in december in honolulu. but i will get you more information. >> thank you. i would like to see this in others come through. you, mr. chairman. >> senator blackburn. >> thank you mr. chairman. i want to thank you all for being here. secretary wilkie, thank you for the time you spent with me prior to this to talk about the needs of some of our veterans in tennessee have. to look at how we fulfill that promise, providing for them and their healthcare. i want to start with the ehrs and your deployment of
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modernization that you are doing there. as we talked many of our folks, would like very much to be able to under the mission act seek that care at home. they are a good distance away from a facility. as we have talked before, interoperability is an imperative in making this work. i want to know where you are, what control measures you have that have been implemented to ensure that you are going to meet your milestones as you go through this deployment. -- deployment as that begins to take place. >> senator, we will go live in march of next year in the pacific northwest to reach our initial operating sites. that is on schedule.
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there are issues that we need to work our way through. these are old facilities. we need to rebuild communication closets and that will go on the -- this summer. we also need to work our way through all of the internet of medical devices and make sure -- >> let me ask you this. as you are doing that are you working on a plan so that when someone enlists on day one, they began a cloud-based encrypted record that will follow them the rest of their life? >> yes, that is the goal. as anill use my father example the days of somebody . carrying around an 800 page april record are gone. >> right but i think it would be , instructive and helpful to us if you could provide us with a timeline of when you will achieve this. now and help committee today they are doing a hearing on the
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ehr's. and we know that whatever you do, that you have to have a strategy so if it is going to be interoperable with commercial best practices and do you have that in place? >> yes, we do, obviously you mentioned the goal is to begin building the record. the minute that young american walks into a military entrance processing statement and then there is a handoff. i expect and i don't know when there will be new changes in leadership at the department of defense but i will continue the , relationship i have with general mattis. i expect to come to this committee with the announcement of a joint program office which will be the first joint program office between two departments so that we combine the resources of both departments to build this record. it will be interoperable. i would never have approved it if we could not have interoperable with the private sector. >> okay. telehealth.
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i was recently in gallatin, tennessee to open a veterans clinic. it is a whole of life clinic. the day after that i was at the nashville va with the mental health center. we were walking through that and i think that those are important components to have. the telehealth helps to bring those services to them, especially in behavioral health. and i want to know, what is your strategy and timeline on moving more facilities so that they are functioning with telehealth and have the whole of life approach to the clinic? we have a lot of clinics, people cannot get to healthcare with a long will waiting list. >> you are exactly correct.
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about three quarters of a veterans consumed telehealth visits last year. that is about 13% of veterans enrolled with us. this year's budget will move that to 20%. we believe in order to keep veterans in their homes , especially at risk veterans, instead of hospitalization, expanding telehealth services is essential. we will move to 20% under this budget. >> i would say this committee has given us authority that no other healthcare system in the country has and it allows our doctors to practice across state lines. this is the front line of our attack on the problems of mental health, as you mentioned, behavioral health. it provides our veterans with the opportunity to stay at home, stay in a comforting surrounding and stay with people who look after them and their friends and families without forcing them to
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go into a larger facility. >> i appreciate that. i know my time has expired. i just want to say listening to you all as you talk about the budget and talk about urgent need, things should never have gotten into this shape. never. it comes from mismanagement. my hope is as you set these timelines for implementing technologies that are going to enable greater access, that you also are utilizing technology to make certain there is not a gross mismanagement that has taken place in times past. >> senator murray. thank you very much mr. chairman, and thank you secretary wilkie and your team for being here. let me start with the fact, caregivers, i'm sure you are shocked i'm going there. the october 1 deadline that the
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caregiver i.t. system was to be certified and begin the expansion process is quickly approaching. the va still has a lot of work to do before then. we have now heard rumors in the press and briefings that the va might not make that deadline. i do really appreciate your personal understanding of the challenges that caregivers face. i know you can appreciate how much our prior era veterans needed support but for the record, will you meet the october 1 deadline to certify the i.t. and begin expanding eligibility for the caregivers program? >> if i don't i will be back up , here. but let me take a step back. the reason that i made the decision not to remove anyone from the caregiver program was because of not only your work and your insistence but because
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this process has been mismanaged in the past. so that was the right thing to do and the reason i made the decision based on your recommendation. the date is october 1. the statute says i have to certify that the system is working. if i do not certify that, no one will be removed. we will continue to manually process the checks. right now, there are 24,000 stipends that go out and it is manually done. but as long as the checks get to our veterans, that is fine with me. we do have a new commercial office shelf technology. if you have not been briefed, i will get you to someone to brief it, that we brought on board on february 22. that is the template that we will be using hopefully. to be ready on october 1. the other side of this is that we have increased the budget primarily because of your work.
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to about $720 million and i expect that to go up in the next few years. but we are also using that money to hire a professional to staff at our caregiver program. >> okay. >> senator, if i may add, this is a manual program today and there are over 24,000 families receiving benefits. their checks are manually written every day. as we move to this commercial system,shelf software what we will need to do is migrate all the data over and assure that we can on an automated basis for the checks every month before we are ready to expand. although we have made a decision on the software system, the migration of that data, we have not recommended a certification date yet on the software system and expansion. >> i'm not going to do it unless it is right. >> i appreciate that.
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at first glance, your request for caregivers looks strong and appears comprehensive. however several components of , the program are in need of research and you mentioned system,, the i.t. planned support systems given to caregivers. all of those will need increased during expansion. your budget requests $150 million for expansion of the caregivers program, leaving $550 million for the needs of the other program. as i have made clear in previous settings i want to be sure the request is not individually under offending expansion or needs of the existing program. i wanted to ask you, how does this funding, especially for the expansion be allocated to the areas of need? >> the basic management structure of this program was done at individual medical centers. this resulted in dramatically different criteria for inclusion and removal from the program. the first thing you will see is the standup of a regionalized management system to look at who
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is eligible and who will be removed. no one will be removed until we can assure you that we are doing this in a clear manner that is transparent to america's veterans and to the american people. as we stand up that regionalized process that will occur under the chief medical officer of each, we remove the individual caregiver being the gatekeeper of this program to a regionalized board process and then institute the appeal process at the va central office. the entire management structure in order to do this to the secretary's standards and standards you expect needs to be stood up and put together. we introduced this concept to leadership last week and have begun talking to the chief medical officers about the hiring and standup of the system. >> the last thing i will say
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senator, i've used your time, we are retraining our clinical staff across the country. -- country with the most modern techniques and information on how to deal with families and caregivers. i would say i think the va is really the only healthcare system in the country that is concentrated on this as the son of a vietnam soldier, it is vital to me. >> i appreciate it and i know you personally care about it too. as you know, i am going to stay absolutely on top of this. we want to implement it correctly and we do not want to deny people the scare they have been waiting for. the help and support and i appreciate your response today. we will stay in close touch. i do have other questions and i will submit them for the record. >> thank you senator murray. senator tillis. >> thank you mr. chair.
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gentlemen, welcome. secretary wilkie it is great to see. first off, i want to thank you all for in your budget request funds to expand the in jacksonville. first off, for people who suggest that there is a trend in the va, or members of congress to privatize, it seems like budget request for the opening of 1 million square feet in three different health care centers in north carolina with a different model you mentioned earlier when i was here seems to suggest you believe the brick and mortar be a presence is a very important part of the future. i would like you to maybe touch on that and tell me how that cbok expansion in jacksonville in combination with the pack teams are going to help improve care there and how do you leverage the model for the rest of the veterans across the country? senator, let me talk about
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the business processes that have led us to that. as i mentioned earlier, we are in the process of doing market assessments across the country to lead into the asset infrastructure review commission. the demographic changes i seem for veterans, changes that mirror those of the rest of the country. by 2027, north carolina will have the fourth highest number of veterans in the country. it will be nipping at the heels of california. >> it will be the eighth largest state. >> yes. for those like senator brown just came in, ohio remains in the top 10. because of the large populations and georgia is also in the top 10 as far as we can see in the future. we have to be more creative. we have to not only combine the brick and mortar facilities that
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we have and manage them more efficiently. but we also have to create an environment where our teams can reach rural areas of our states and be more creative when it comes to things like telehealth. but we are moving our resources to where the veterans are and i think that dr. stone has your pack answer. >> the packs will continue to expand across the nation as we higher. in montana alone we have 38 , primary care providers. we have office out to 8 additional primary care providers who will come in and expand the rural area. the secretary is exactly correct that we are seeing growth in georgia,rida, south growth in your state, sir, and we will continue to expand. let me talk about brick and mortar. veterans are no different than the rest of americans.
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our parents' generation stayed in the same house on a generational basis. we don't. and our children don't. they move. we must be able to move from place to place in order to follow where the veterans go. the therefore, lease authorities are incredibly important to us and enhance lead authorities -- lease authorities that allow us not to just provide but to also be able to provide ambulatory medical facilities that we can move every 5 to 10 years and follow where america's veterans are. much of the nonrecurring maintenance you hear about and cost of our infrastructure is for our inpatient facilities. our inpatient facilities in many cases are aged and need substantial improvements. but ambulatory facilities, more than 1000 of them need to be able to be mobile when the veteran moves each decade. >> thank you. i want to talk a little bit
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about access to standards in the mission that. -- mission act. i could infer from some comments from some of my colleagues it is almost like we are giving some of our veterans too much choice. in some states, i think you 100% access to choice if you want it. there may be a variety of reasons why you need that. my colleague just came from alaska and has a very diverse population over a geography that almost spans the united states toe. i can see why you have to have different solutions for different states. what would happen or be the negative consequence if concert succeeded in rolling back the ask for standards you're putting in place and in combination with the mission act? senator, it would no longer
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be a veteran-centric, patient-centric approach to healthcare. that was the clear mandate of the mission act. not institutional prerogative but the healthcare of a veteran. let me back the chairs indulgence to describe what this is. and i mentioned it earlier. this is not a libertarian va. this is not giving dr. stone or me a card and saying, thank you very much, go out and find whatever doctor you want to take care of you for the rest are you like. what this says if we cannot provide a service, then you have the option to seek that service in the private sector. to give an example, there is no -- if there is no rheumatologist in fayetteville and you meet the criteria for that service, then we tell you that you have the option to go to duke or chapel hill or to cape fear valley in my hometown to get that service. it is based on the needs of the veteran and veterans come first. if we cannot do what the veteran needs, then we will provide him the opportunity to seek that. i think it is very important
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mr. chair to close out my questions. >> that is why i think a broader understanding of what you are trying to accomplish with the patient care teams, it is not like you're giving them a card and sending them on their way. you will have to spend a lot of time making sure that the outcomes are going in the right direction and they're getting the equipment filled when you need to. you will always have the brick and mortar presence when necessary. but i think that the standards we need to move forward in the work you are layering on top of it will provide a better standard of care for the veterans. thank you for your work. >> thank you. senator brown. >> thank you mr. chairman and secretary wilkie. thank you for your letter back to me regarding the ba history center at the va in dayton, ohio and we are excited to get the next phase up and running. we look forward to a briefing on how this project is progressing and we will be in touch about that. i will be brief. i have a number of questions. senators tester, bozeman and i have been working to push for a
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track and report of overpayment and veteran debt. who reportedtuents a change in status or dependency to va and the va did not take action leading to overpayment and death. we are able to get provisions through last year. last week, we introduced the updated bill that clearly outlined the reporting process for veterans and families to foster better interagency coordination, reduce overpayments. i would like your commitment to -- that the ba will continue to work with the three of us. >> >> yes, sir. thank you. -- >> yes, sir. >> thank you. >> over the last month this is a bit of a follow-up to comments and questions about toxic exposure. over the years, you and i have discussed the issue whether it is agent orange or burn pits that took the country far too long to come to terms with. each veteran did not have to apply individually and go through that pain. i appreciate the decision not to appeal on the blue water navy, that is really important.
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>> that is my recommendation. i do not know what other departments are doing. >> that is your recommendation, okay. my question is this, i would like to know when the va intends to make a decision regarding the national academy recommendations on agent orange bladder cancer, hyperthyroidism, hypertension and parkinson's like syndromes? >> we are working our way through that right now. and it would be my hope within the next 90 days that we will have decisions made. >> okay. you make the decision quickly as ratified by secretary wilkie? >> i would not presume when the secretary -- >> he sitting right next to. you might ask him. >> thank you. >> secretary you said that , congress put unreal expectations on outdated i.t. systems for the forever g.i. bill. sir, the va i.t.
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and programmatic offices should be able to flag these issues for leadership and leadership should respond accordingly and update congress. >> if i said that, i misspoke. i should have said the va systems were not capable of handling changes that congress mandated. >> but they will be? >> they will be. similarwent through issues with expansion pair why did that take six to seven months as well? >> that i cannot tell you based on my tenure here. my short tenure. what i can tell you is that once again, because we were not ready to implement the programs required to support our caregivers, i made a command decision based on my discussion with senator murray that to make sure that nobody was removed
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from the program, that the checks, the stipends that i went -- that went out to 24,000 caregiver families were done manually but they were done. and i do expect to come to this congress by the deadline on october 1, hopefully certifying that the commercial off-the-shelf technology that we purchased to support caregivers is in place. but i will say i'm not going to certify anything that doesn't work. we have been down that road he for. that led to problems with the forever g.i. bill and the problems with caregiver. you have my commitment that nothing moves unless we are convinced that it helps veterans. >> thank you. i want to reiterate with the chairman said about the legacy i.t. systems getting them to , work together for all of our veterans. that is so important. one more comment and one last question. the comment is -- well the question is, when can we expect nominees for deputy very
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-- deputy secretary and undersecretary of health? hopefully soon, we have made the recommendations and i hope there will be an announcement from the white house shortly. i will thank the committee for approving the nominees for the office of whistleblower protection and cio. i do want to say one thing, though. there is an added layer of approval for the under secretary for health. the law, unlike for any other position in federal government, requires the convening of a commission, a commission to meet, deal with candidates, deliberate, and then pass a recommendation onto me. that was the reason for the delay and the 8 months i was here because the commission had to be convened. >> last comment, i heard -- thank you, mr. chairman for your forbearance.
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i heard your junior senator for north carolina is laying out choice and privatization and i know how he stands on that. i have been disappointed that you are quite as opposed to privatization as i thought. i'm not asking a question , particularly but i just ask , you to listen to the veterans service organizations and what they think about this presidents -- president's philosophical commitment to privatization that i hope the v.a. doesn't follow. >> i think i have been very clear, mr. chairman, about where i stand and where i think the department is headed. i think the legislation was right on target when it said that the veteran is at the center of everything that we do. i also said that the veterans voting with his or her feet. our customer satisfaction rates are at an all-time high. i look at that is the gauge as to how will we are doing. i also believe and i'm not one
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to use a lot of anecdotes but i can say as someone who has spent an entire life in and amongst the military, that our veterans, no matter what age they are, will go, primarily, to someplace where people speak the language and understand the culture. there is nothing like it in the united states. i stand by what i have done in the last eight months. >> the way that congress appropriate or holds money can have a lot of people voting with their feet and we hope you will keep that in mind. thank you, mr. chairman. >> thank you, mr. chairman and your secretary and your team. thank you for being here. i also mentioned the nominees for undersecretary, very important. we need to get those out the door and i also want to mention to my democratic colleagues they also need not to delay the nominees once they are on the floor. there has been very, very
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unprecedented of structured of very basic nominees for their confirmation. we get them out the door and we will have guys like senator brown move them quickly as opposed to delaying them because that is not helping at all so it wasn't a nice try, it is actually a very serious issue so they need to help. they can't just say, "give us nominees" and then delay them for 10 months. it is ridiculous and that is what has been happening. let me mention first of all congratulations on these , national awards. i think what you are talking about for your team, it's, should be commended and sometimes you guys come here and you get the wrath of the congress and we rarely recognize when there has been improvement so i'm going to recognize it and , i appreciate it. keep up the good work on these things. you may have also noticed that alaska va healthcare system was
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also awarded with the most improved inpatient experience 2018. for the entire country in i want to thank all of you for that. dr. ballard is one of the best. >> dr. ballard does a great job but it is help from the top, you know, the va out in the matsu valley, a huge veteran population, finally has not just 1, not just 2, but 3 doctors. it only took 5 years but now we have some doctors. and mr. secretary, i want to thank you, not exact you exactly in your purview but you may have seen my alaskan native vietnam veterans equity allotment act was recently signed into law and when the president cited the broader bill he highlighted this , very important bill for alaska that helped our vietnam veterans overcome a huge injustice. the fact that the president
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highlighted that in a signing ceremony made me -- that and add to mention that caregiver legislation closes one of the last moves of the vietnam era, sadly. it has been 44 years since the fall of saigon. i think the alaska allotment issue was one that, sadly, took almost as long and i think that also closes a loop, particularly for a state that has the highest per capita number of veterans in the country. >> i appreciate that, mr. secretary. and you weighing in on that, h mer secretary zinke weighing in on that, again, previous administrations, remarkably, they were opposed to it so you guys at the cabinet level work weighing in really helped make it happen so i want to thank you for that. i wanted to talk about the veterans benefits administration
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is working on and i know it is a big issue for you, identifying off the v.a. grid veterans who have yet to make contact with the vba and its services. i know you are looking at possibly doing a case study in alaska. you have been out there, and i look forward to you and dr. stones visit here soon. but, can you talk a little bit about that, whether it is a pilot program in alaska? we do have enormous challenges on this issue but also how you are working it in other rural communities throughout the country? >> certainly, you may recall that a confirmation time when i visited with you you spoke about your reference to engaging with -- to engage your constituents. i did not forget the conversation and i set in motion to figure out how we do that. our presence is augmented by the relationship with the county and state via tribal and communities to figure out how the network should be set up so if you can't touch as, you can touch somebody, touch us and that is what we are trying to do, and we are using alaska to
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engage those groups to figure out how the working of that takes place in what we can do in terms of the way we communicate and the way it affects the way we do that. we are trying to figure out how immobilize all of the resources that are in the veteran vso's included, toal figure out how we do those touches. how about the pilot program in alaska? >> you will have to brief me on some of the details. >> we are getting started on that. mr. secretary, i know you have been asked by senator boseman and others, on how you are feeling with regard to the mission act, launch date, alaska has been carved out its own region, region 5, there has been some concern that we are behind the power curve there a little bit relative to the rest of the country. can you give me up a quick update? >> actually, because of the
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uniqueness of the geography and the dispersion of the population, i worry about it a lot. we are on schedule, though, for getting out the contract and so when i say that, the bid should be out, it should be this fall. >> what can we do to ameliorate your concerns and worries, i share them. >> i think just the continuing dialogue with your staff and yourself. i'm looking forward to my visit where we can dialogue and work our way through it but it is a unique area with geographical challenges and you are exactly correct in our previous conversations -- it should be handled locally. >> i will add, if you do go down the list, and i have said this to folks in alaska, the federation of natives, i have said it on alaska television. if you go down the list and look what we are prototyping in the va, my philosophy on electronic
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health, on logistics, on vba, and here with mission is if we can make it work in alaska, it will work anywhere because of the unique challenges that alaska presents by its massive size but also because of the impact the veterans have on the population of the state. it is a unique, unique situation. >> thank you all, we look forward to you getting back up there, mr. secretary and dr. stone, your visit as well . >> i have one additional question so if you don't mind, mr. secretary and i will have one very short statement after this question. >> unfortunately, the chairman almost told the truth. i have two develop while i was waiting for one. we have to hurry. i wanted to go back to the hearing aid specialist for a moment and this really is to you, mr. secretary.
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i understood what dr. stone said, that the va may have reached the conclusion it does not believe that additional professionals in this arena are necessary but i want to highlight a complaint i have had with the department of veterans affairs for as long as -- which is now 23 years i have been on a committee on veterans affairs, is can we get the department to abide by the congressional law, the mandate that you have and the issue of whether or not the specialists are necessary to the va. that is a different issue than abiding by the law to determine what the qualifications would be for that profession at the va. i don't want to diminish this issue. it is important to many people and important to many people who are hearing specialists who want to provide the services, serve our veterans. it is important to veterans that they have the care necessary but i just, knowing you, mr. secretary, i want to highlight about the importance of just the folks who work for you, not making an independent decision whether or not they get to abide by the law, the mandate congress gave them to act in any articular way. >> yes, sir. i did know that that is current. that is my honest answer and you
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know my background so they will be told to abide by congressional will. >> i think it is true when you are confirmed. it is true as i recall in every confirmation hearing for secretary at the va that my question has been, will you make certain to people who work with you, work with congress, provide the information we need, answer our letters and of course, given is abide by the law. i want to highlight the importance of that. we raised the issue of toxic exposure and i told you about a study that was completed by the national academy of medicine in november, 2018. that law that created the study requires you, mr. secretary, to determine, based upon that report, within 90 days, if there is a trigger in that law and it requires you to make a determination about now how to proceed. and i just learned that march 22 , which was just a day ago, you have sent a letter to the committee. you are now, you were not in
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compliance at the 90 day but you are in compliance by responding and i appreciate that. you now have a responsibility that i want to work with you to make certain that there is action taken. again, we are talking about the generational consequences. the national academy determine d there is no medical research that determines the relationship between toxic exposure and the next generation of the veteran. there is a great opportunity and a necessary opportunity for you and the department of defense to proceed in determining that relationship but also getting the facts in place so that we can determine who those veterans are and you are a perfect person with your relationship and history with the department of defense to accomplish this goal. >> i will digest your march 22 letter in were timely fashion but this is something i wanted to highlight for you. thank you. >> thank you, chairman. senator sullivan wants to ask one more question i want to grant him that privilege. >> thank you, mr. chairman.
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it is just one. mr. secretary, this goes to the issue of infrastructure improvements, streamlining expansion when you see the population growing in certain areas of the country and state populations that are declining and again, in your -- i know that broadly, the va is repurposed or disposed of 175 of 430 vacant or mostly vacant building since june 2017. that makes a lot of sense but you also talked to me about areas that you see, if the va is looking at expansion with regard to leases or even facilities, i know you were struck by some of what was going on in alaska and given that you mentioned not only more vets per capita, the size but also we are one of the few states that does not have a full service va hospital, not even one. can you just give me an update on what you are thinking as far
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as the v.a.'s prioritization of leases in the budget request? in fairbanks, we are looking at the possibility of a new campus and also outside of jaybird, you may have remembered the big parking lot area we were talking about after our tour. >> the simplest answer is that we are going with the veterans, where they are. this is only the first step. the legislations requires market assessments to be done throughout the country and we are in the process of doing that . that develops a knowledge base on population trends, the services available in those areas to inform and asset infrastructure review commission. i mentioned earlier that i expect to come to this committee to ask for an accelerated date for the beginning of the deliberations on the asset infrastructure of your
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-- review commission because we have to go where the veterans are. i also mentioned earlier that what you said is only the beginning of many different processes. more than half of our buildings, 57% are between the age of 50 our buildings are between 50 and 37 years old. because of that the leasing option and co-locating and i'm not going to say that we're in the process of doing this, but i saw a number of facilities in alaska that present us with the opportunity to be more creative co-locating with entities outside of the federal structure. thank you. >> thank you, mr. chairman. >> thank you, senator. let me conclude the meeting by thanking the secretary of the
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if this works well we'll get better responses because we consumed so much time and we
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don't have all the witnesses and we don't get the points we need to get to as demonstrate by mr. sullivan and mr. moran. i want to thank you for being here. thank all the veterans they provide to all oufs. wish you a very nice day and a very happy week. i look forward to seeing you soon. and it will be five days of submissions to this hearing. and the secretary will respond as quickly as possible. if you'll get the questions to the committee, right? he will make sure you get to the secretary. you have a copy of it. thank you very much. we thank you, sir. >> thank you. [captioning performed by national captioning institute] [captions copyright national able satellite corp. 2019]
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[conversational chatter] announcer: on capitol hill next week, the house will consider reauthorization of the violence against women act which expired in february. members are also expected to take up a senate pass resolution to end military involvement in yemen, self-war. the senate work continue os a bill that will provide some $13 billion in aids by areaing affected by hurricanes, wildfires and other natural disasters. also on the agenda, a resolution that would shorten the senat has
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to consider lower level nominations from 30 hours to two hours. you can watch the house live here on c-span and the senate live on c-span2. nouncer: this week on "the communiqators," michael powell. he is interviewed by cat sekresky. >> i think the industry is in transition. but it's talk of demise are dramatically premature. i think the industry has nicely transitioned to the significance of broadband and help compensate for the competitive pressure on the video. i think they managed the video better than people would have imagined. i think they're thriving as businesses as consumer delivery systems. they announced 10g in which they attempt to dramatically increase
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. oadband speed to the homes > watch "the communicators" on c-span2. >> next an american history tv exclusive. our cities tour visits pasadena, california to learn more about its unique history and literal rare life. for eight years now, we traveled to u.s. cities bringing the literary scenes at historic sights to our viewers. ou can watch more at c-span.org/citiestour. welcome to pasadena located just 10 miles from los angeles. this city of 150,000 residents sits at the base of san gabriel mountains. with help from our spectrum cable

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